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Association Between Middle Ear Anomalies and the Severity of Mandibular Deformity in Hemifacial Microsomia
Yang Zhang1, Jinchao Yu2, Xinhai Ye2
1ENT Institute, Eye & ENT Hospital of Fudan University, Shanghai, China.
Objectives:
Hemifacial microsomia (HFM) is frequently associated with middle ear anomalies. This study aimed to investigate the association between middle ear anomalies and the severity of mandibular deformity in patients with HFM.
Methods:
We retrospectively analyzed patients with HFM treated at the Eye and ENT Hospital of Fudan University between 2017 and 2025. The severity of mandibular deformity was classified using the Pruzansky-Kaban classification system. External ear anomalies were graded according to the Marx classification, and middle ear morphology was evaluated using high-resolution computed tomography with the Jahrsdoerfer scoring system. Audiological outcomes were assessed using pure-tone audiometry. Correlations between mandibular classification and middle ear structures were analyzed using the Kruskal-Wallis H-test, and hearing outcomes were compared using independent samples t-tests.
Results:
A total of 51 patients were included in this study. External ear deformities and malleus-incus complex abnormalities were prevalent across all HFM subtypes. Incus-stapes articulation differed significantly between type I and type II HFM, and between type I and type III HFM. Significant differences were observed in stapes morphology between type I and type III HFM, as well as between type II and type III HFM. Middle ear cavity development and mastoid pneumatization were significantly reduced in type III HFM compared with type I HFM. Inner ear anomalies were infrequently observed and were limited to a small subset of patients with severe HFM. Patients with more severe mandibular deformities demonstrated larger air-bone gaps and poorer air-conduction thresholds.
Conclusion:
In patients with HFM, the severity of mandibular deformity is significantly associated with middle ear structural abnormalities, including the ossicular chain, middle ear space, and mastoid pneumatization. Assessment of middle ear morphology may provide valuable adjunctive information for disease stratification, hearing outcome prediction, and surgical planning in HFM.
